Ankle and calf exercises will assist venous return. If there is no risk of arterial compromise or congestive fluid overload, compression therapy (usually in the form of compression hosiery) can be used to reduce the oedema (Stalbow 2004). It is important to perform a vascular and holistic assessment before choosing and fitting any compression hosiery, and to assess the patient’s ability to apply and remove the garments. Lack of consideration of these aspects can lead to poor adherence or, at worst, arterial compromise and amputation of the limb (Wounds UK 2005). Vascular assessment should include calculation of the ankle brachial pressure index. Patients with cardiac oedema need to be treated with caution when considering application of compression therapy, as rapid fluid displacement can further overload the heart (Muldoon 2011). If the patient is suitable for compression therapy and the legs continue to leak exudate, a compression bandage system may be more appropriate as this will retain the exudate more effectively. Recurrence of cellulitis is common (Cox et al1998), possibly because the cause of the infection may not have been identified and therefore not treated effectively, or because ongoing lymphoedema, tinea pedis, leg ulcers or other chronic skin conditions have been previously identified as risk factors. Patients should be advised of these risk factors and given information on how to reduce the risk of recurrence of the condition.
Ankle and calf exercises will assist venous return. If there is no risk of arterial compromise or congestive fluid overload, compression therapy (usually in the form of compression hosiery) can be used to reduce the oedema (Stalbow 2004). It is important to perform a vascular and holistic assessment before choosing and fitting any compression hosiery, and to assess the patient’s ability to apply and remove the garments. Lack of consideration of these aspects can lead to poor adherence or, at worst, arterial compromise and amputation of the limb (Wounds UK 2005). Vascular assessment should include calculation of the ankle brachial pressure index. Patients with cardiac oedema need to be treated with caution when considering application of compression therapy, as rapid fluid displacement can further overload the heart (Muldoon 2011). If the patient is suitable for compression therapy and the legs continue to leak exudate, a compression bandage system may be more appropriate as this will retain the exudate more effectively. Recurrence of cellulitis is common (Cox et al1998), possibly because the cause of the infection may not have been identified and therefore not treated effectively, or because ongoing lymphoedema, tinea pedis, leg ulcers or other chronic skin conditions have been previously identified as risk factors. Patients should be advised of these risk factors and given information on how to reduce the risk of recurrence of the condition.
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